CER Comparative Effectiveness

Are minimally invasive surgeries worth the cost?

In the past decades, many surgeries have gone from a standard, open surgical approach to a minimally invasive one using laproscopic, endoscopic, and catheter based techniques.  What has been the effect of these innovations on medical spending and employee absenteeism?

To answer this question, a paper by Epstein et al. (2013) examines a sample of adults aged 18 to 64 years who were enrolled in employer-sponsored health insurance and underwent 1 of 6 types of surgery. The six types of survery include:

  1. coronary revascularization (coronary artery bypass graft surgery vs percutaneous coronary interventions);
  2. uterine fibroid resection (open abdominal hysterectomy and myomectomy vs vaginal/laparoscopic hysterectomy, vaginal/laparoscopic myomectomy, and uterine artery embolization);
  3. prostatectomy (radical vs laparoscopic [with or without robotic assistance]);
  4. revascularization of peripheral arterial occlusive disease (open surgery vs endovascular treatment);
  5. carotid revascularization (carotid endarterectomy vs carotid arterial stenting); and
  6. aortic aneurysm repair (open vascular surgery vs endovascular treatment).

The authors use commercial claims data from the  Truven MarketScan Research Databases (formerly Thompson Reuters Marketscan).  These claims data are collected from health plans and self-insured firms.  The data also have information on employee absenteeism.

The authors find the following results:

…mean health plan spending was lower for minimally invasive surgery for coronary revascularization (−$30 850; 95% CI, −$31 629 to −$30 091), uterine fibroid resection (−$1509; 95% CI, −$1754 to −$1280), and peripheral revascularization (−$12 031; 95% CI, −$15 552 to −$8717) and higher for prostatectomy ($1350; 95% CI, $611 to $2212) and carotid revascularization ($4900; 95% CI, $1772 to $8370). Undergoing minimally invasive surgery was associated with missing significantly fewer days of work for coronary revascularization (mean difference, −37.7 days; 95% CI, −41.1 to −34.3), uterine fibroid resection (mean difference, −11.7 days; 95% CI, −14.0 to −9.4), prostatectomy (mean difference, −9.0 days; 95% CI, −14.2 to −3.7), and peripheral revascularization (mean difference, −16.6 days; 95% CI, −28.0 to −5.2).

Although the authors control for observable patient characteristics (e.g., age, comorbidities), it could still be the case that people who receive minimally invasive surgery are different from those who do not (e.g., in unobservably better health). Nevertheless, it seems sensible that less invasive surgical techniques reduce complications, recovery times and work absences.


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